Francesco Carbonetti MD, Presenter: Nothing to Disclose

Antonio Cremona, Abstract Co-Author: Nothing to Disclose

Daniela Sergi, Abstract Co-Author: Nothing to Disclose

Marco Guidi, Abstract Co-Author: Nothing to Disclose

Valentina Carusi, Abstract Co-Author: Nothing to Disclose

Marco Di Girolamo MD, Abstract Co-Author: Nothing to Disclose

Danilo Guida, Abstract Co-Author: Nothing to Disclose

Vincenzo David MD, Abstract Co-Author: Nothing to Disclose

To evaluate the diagnostic efficacy of the CT findings in predicting the diagnosis of Necrotizing Fasciitis (NF).

In a period of a year 36 pts with a clinical suspicion of NF underwent to CE-MDCT .CT findings studied were : involvement and thickening of the muscular fascia, fluid collections along the deep fascial sheaths , extension of oedema into the intramuscular septa and the muscles, low attenuation areas in the deeper fascial planes suggestive for colliquative necrosis, a non enhancement of the muscular fascia and vascular thrombosis.Radiological findings were compared with the LRINEC score and with the surgical data.

CT findings were suggestive for NF in 10 pts , for non-NF in 2 pts and for gas-gangrene in 2 pts .The rest of the pts showed CT finding suggestive for cellulitis (10 pts) , myositis (5 pts) , soft tissue abscess ( 7 pts).Among the patients with CT findings suggestive for NF, non-NF and gas gangrene , 9 pts showed a non enhancing fascia, subcutaneous gas was present in 12 pts, involvement of the fascia in 12 pts, fluid collections along the deep fascial sheaths in 7 pts ,low attenuation areas in the deeper fascial planes in 3 pts. Surgical examination confirmed the diagnosis of NF in 12 pts who showed at the CE-MDCT a non enhancement of the fascia (9/12), low areas of attenuation (3/12), fluid collections ( 4/12), presence of subcutaneous gas (10/12) . The LRINEC score in pts with NF was equal or superior to 6 points : 6 pts had a score of 6/8 , 4 pts a score of 7/8 , 2 pts a score of 8/8 . The diagnoses of the other pts (cellulitis 10 pts, myositis 5 pts, musculoskeletal abscess 7 pts) were confirmed.

The presence of a non-enhancing fascia after contrast medium administration, the involvement of the fascia and the presence of subcutaneous gas are the radiological findings mostly related to NF, and could strongly suggest to the radiologist the presence of NF; these findings with an intermediate-high LRINEC should address to a surgical evaluation. CT could discriminate NF from the most common musculoskeletal infections.

NF is a fatal disease if it is not treated, in order to permit a prompt surgical intervention radiological findings correlated with the LRINEC score permit a better evaluation of the pts disease and a prompt surgical intervention in order to avoid the complication of NF.

Carbonetti, F, Cremona, A, Sergi, D, Guidi, M, Carusi, V, Di Girolamo, M, Guida, D, David, V, The Role of MD-CECT in the Diagnosis of Necrotizing Fasciitis and Correlation with the LRINEC Score.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011203.html